Occupational Safety

The Occupational Safety and Health Administration (OSHA),
Best Practices
for HOSPITAL-BASED FIRST RECEIVERS OF VICTIMS from Mass Casualty Incidents Involving the Release of Hazardous Substances:


Healthcare workers risk occupational exposure to chemical, biological, or radiological materials when hospitals receive patients contaminated with these substances during mass casualty incidents. Such incidents could be associated with manmade (intentional or unintentional) or natural disasters and can involve a wide range of hazardous substances—from chemical weapons agents to toxic industrial chemicals .

First receivers typically include personnel in the following roles: clinicians and other hospital staff who have a role in receiving and treating contaminated victims (e.g., triage, decontamination, medical treatment, and security) and those whose roles support these functions (e.g., set up and patient tracking)

"Protective equipment, including personal protective equipment for eyes, face, head, and extremities, protective clothing, respiratory devices, and protective shields and barriers, shall be provided, used, and maintained in a sanitary and reliable condition wherever it is necessary by reason of hazards of processes or environment, chemical hazards, radiological hazards, or mechanical irritants encountered in a manner capable of causing injury or impairment in the function of any part of the body through absorption, inhalation or physical contact."


First Responder

Initial training

Annual refresher

Both initial and refresher training may be satisfied by demonstration of competence.
All employees with designated roles in the Hospital Decontamination Zone This group includes, but is not limited to:
  • Decontamination staff, including decontamination victim inspectors; clinicians who will triage and/or stabilize victims prior to decontamination; security staff [e.g., crowd control and controlling access to the emergency department (ED)]; set-up crew; and patient tracking clerks.
OSHA, 2003,
1992c, 1999
Briefing at the time of the incident Other employees whose role in the Hospital Decontamination Zone was not previously anticipated (i.e., who are called in incidentally).

(e.g., a medical specialist or trade person, such as an electrician)
OSHA, 1997

First Responder

Initial training

Annual refresher

Both initial and refresher training may be satisfied by demonstration of competence.
  1. Security personnel, set-up crew, and patient tracking clerks assigned only to patient receiving areas proximate to the Decontamination Zone where they might encounter, but are not expected to have contact with, contaminated victims, their belongings, equipment, or waste.
  2. ED clinicians, clerks, triage staff, and other employees associated with emergency departments, who might encounter self-referred contaminated victims (and their belongings, equipment, or waste) without receiving prior notification that such victims have been contaminated.
OSHA, 1991a, 1991b
Training similar to that outlined in the Hazard Communication Standard Other personnel in the Hospital Post-decontamination Zone who reasonably would not be expected to encounter or come in contact with unannounced contaminated victims, their belongings, equipment, or waste.

(e.g., other ED staff, such as housekeepers)

29 CFR 1910.1200(h)

The employer must certify that personnel trained at the “First Responder Operations Level” have received at least eight hours of specific training (which can include Awareness Level training, PPE training, and training exercise/drills), or have had sufficient experience to objectively demonstrate competency in specific key areas.

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